Glaucomatous optic nerve head alterations in patients with chronic heart failure

RETINAL VASCULAR DENSITY CHANGE IN PATIENTS WITH HEART FAILURE

PURPOSE

The aim of this study is to assess choroid thickness, retinal vessel density in the superficial capillary plexus layer and deep capillary plexus layer in heart failure (HF) using optical coherence tomography angiography (OCT-A).

METHODS

36 healthy participants (group 1), 33 patients with HF were assessed for this study. HF patients had a left ventricular ejection fraction (LVEF) <50%. HF patients were divided into 2 groups according to the New York Heart Association (NYHA). 15 patients were evaluated as group 2 according to NYHA and 18 patients as group 3 according to NYHA. Choroid thickness, superficial and deep capillary plexus perfusion were analyzed between groups using OCT-A.

RESULTS

Choroid thicknesses were found to be significantly decrease in the HF groups. Superficial capillary plexus density was compared with the control group, no statistically significant difference was found between the HF groups. But among the HF groups, a statistically significant decrease was found in group 3 patients. Deep capillary plexus density was compared with the control group, a statistically significant decrease was found in group 3. In addition, deep capillary plexus density a statistically significant difference was found between the groups HF.

CONCLUSIONS

Patients with HF showed decreased flow density compared with healthy controls. In addition, significant changes were found in flow densities among the HF groups. Retinal perfusion measured using OCT-A may give an idea about the hemodynamic status and microperfusion of HF patients.

Ocular perfusion in patients with reduced left ventricular ejection fraction measured by optical coherence tomography angiography

AIMS

The aim of this study is to evaluate retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects.

METHODS

Twenty-seven eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had a left ventricular ejection fraction (LVEF) < 50% and were classified by New York Heart Association (NYHA) class. OCT-A was performed using RTVue XR Avanti with AngioVue (Optovue, Inc, Fremont, CA, USA). The area of the foveal avascular zone (FAZ) and flow density (FD) data were extracted and analyzed.

RESULTS

There was no significant difference in the signal strength index between the study group (group 1) and the control group (group 2) (ONH: p = 0.015; macula: p = 0.703). The difference in the area of the foveal avascular zone between the two groups was also not significant (p = 0.726). The flow density (whole en face) in the ONH (RPC) in group 1 was significantly lower compared to control (group 1 = 48.40 ± 2.48 (49.0 [46.7, 50.3]); group 2 = 50.15 ± 1.85 (50.6 [48.5, 51.70]); p = 0.008). There was a significant and strong correlation between LVEF and the macular flow density (whole en face) (superficial: rs = 0.605 deep: rs = 0.425, p < 0.01).

CONCLUSIONS

Patients with CHF showed reduced flow density compared with healthy controls. The reduced FD correlated with the LVEF and the functional (NYHA) class. Retinal perfusion as measured using OCTA might provide an insight into the global microperfusion and hemodynamic state of heart failure patients.

Association between vascular comorbidity and glaucoma progression: A four-year observational study

Glaucoma, one of the significant causes of blindness worldwide, is a chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells and specific perimetric defects. This study aimed to assess the association between the risk of glaucoma progression and different systemic vascular abnormalities. A 4-year prospective study was carried out on 204 patients diagnosed with open-angle glaucoma. Associated systemic vascular pathology was documented in 102 cases. Progression was encountered in 57 (55.9%) patients with vascular comorbidities and only in 10 (9.8%) patients with no associated vascular diseases (OR 13.81, P<0.01). The vascular risk factors associated with glaucoma progression in the study group were diastolic hypotension (OR 5.444, P=0.027), ischemic cardiac disease (OR 5.826; P<0.01), peripheral vasospasm (OR 3.108, P=0.042) and arterial hypertension (OR 2.593, P=0.05). Diabetes was not significantly correlated with progression in the study group, but only patients without diabetic retinopathy were included. This study highlights that systemic comorbidities associated with endothelial lesions, atherosclerosis and hypoperfusion can lead to damage to the retinal nerve fiber layer and the underlying conjunctive tissue.

Investigating Ganglion Cell Complex Thickness in Children with Chronic Heart Failure due to Dilated Cardiomyopathy

PURPOSE

To assess ganglion cell complex (GCC) thickness in children with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM) using optical coherence tomography (OCT).

METHODS

Sixty eyes of 30 patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCM) and 60 eyes of 30 age- and sex-matched healthy volunteers (control group) were enrolled. The mean age of the patients and controls was 9.9 ± 3.57 (range 5-17) years and 10.08 ± 3.41 (range 4-16) years, respectively. All patients underwent a complete ophthalmic assessment and OCT imaging using RTVue XR Avanti (Optovue). The following OCT-based parameters were analysed: average ganglion cell complex thickness (avgGCC), superior ganglion cell complex thickness (supGCC), inferior ganglion cell complex thickness (infGCC), global loss of volume (GLV) and focal loss of volume (FLV).

RESULTS

There were no significant differences in avgGCC (98.13 μm vs. 99.96 μm, p = 0.21), supGCC (97.17 μm vs. 99.29 μm, p = 0.13), infGCC (99.03 μm vs. 100.71 μm, p = 0.25), FVL (0.49% vs. 0.4%, p = 0.25) and GVL (2.1% vs. 1.3%, p = 0.09) between patients with chronic heart failure due to dilated cardiomyopathy and healthy children. There was no correlation between avgGCC, supGCC, infGCC, FLV, GLV and ocular biometry, refractive errors or age. There was no correlation between avgGCC, supGCC, infGCC, FLV, GLV and NT-proBNP or LVEF. There were no significant differences in the studied parameters between the sexes. There were no significant differences in the studied parameters between the left and right eye.

CONCLUSION

Our study seems to be the first to analyse ganglion cell complex in paediatric patients with dilated cardiomyopathy. We have demonstrated no changes in the ganglion cell complex thickness parameters in children with chronic heart failure due dilated cardiomyopathy, as compared to their healthy peers.

Glaucomatous optic neuropathy management: the role of neuroprotective agents

Glaucoma is a major cause of worldwide irreversible blindness. The central role of raised intraocular pressure (IOP) is being questioned as many patients continue to demonstrate a clinically downhill course despite initial control of IOP. The latest concept of recognizing glaucoma as a multifactorial, progressive, neurodegenerative disease of retinal ganglion cells (RGCSs) associated with characteristic axon degeneration in the optic nerve emphasizes that several pressure-independent mechanisms are responsible for the development and progression of glaucomatous optic neuropathy. Neuroprotection as a pharmacological strategy to mitigate retinal ganglion cell death has been a popular current approach. The aim of this review is to evaluate the neuroprotective potential of calcium channel blockers in glaucomatous optic neuropathy.